Communities Singing about Health Messages for a Healthy Pregnancy Creates Awareness of Pathways to Safer Pregnancy and Childbirth in Households in Rural Nepal

In the Parbat district of Nepal, four rural Village Development Committees were randomly grouped (two each) into two clusters. A structured questionnaire was used to collect baseline and post-intervention data. An equal number of adult male and female heads of households were invited for the interview. Consents were sought from the respective Village Development Committees, schools and respondents involved. In the intervention cluster, Community members were invited to write health song lyrics which were later presented in a song competition organised and judged by the community. To facilitate this process to happen, a total of 23 orientation sessions were organised for teachers, students, mothers group members and youths about the key health message area (below). These orientation sessions were delivered by the research student (Binod B Sharma)who comes from Nepal and knows the local language and culture. These sessions were organised in the schools, villages, small townships of the village and in the working fields wherever people were available. Sessions were organised in a group environment. In addition to the information about the key message area for songwriting, he discussed the song competition program to be held in the community. Each orientation session took approximately 90 minutes to deliver and clarify the questions. The key message areas below were the subject of discussion during the orientation session. This was to orient them on the areas in which they will be writing song lines. In each 23 sessions, the uniform message about the key message areas and competition program were discussed. There were 26 groups of people participated in the song competition. The most accailamed songs were taken to the intervention for house to house singing progression. Given the overwhelming participation of the community and the culturally appropriate method of diffusion, teachers were enthusiastic to take on the role of disseminating the health messages in the community. The teachers, school management committees, village secretaries, and others decided the composition of the singing team. The training for both intervention teams was organised in Ramja Deurali. During training, there were sufficient rehearsals of the songs to ensure their smooth presentation in the field. During training, participants prepared a specific intervention plan for their area with the route of the intervention. Local teachers then led the awareness program, singing the health messages in a house to house community progression. The singing sessions were continued from morning until evening while organising in the village to village environment. The singing session normally took around 75 minuses per session. In the Chitre Village Development Committee, a group of six teachers were identified for the singing intervention. The Chitre intervention progression was completed in ten days, from 14th to 23rd July 2016. In Ramja Deurali, one teacher was nominated to lead the team. Other members of the group included a traditional singer, adolescents, former students, and one local villager. The progression in Ramja Deurali took eight days, from 5th to 12th August 2016. A total of 80 singing sessions were organised covering all the households in the intervention cluster. The sessions were essentially held wherever people were present; for example, they were held in individual houses, in the common area of the village, schools, on the roads, and even in the fields where a group of people were working. A total of 2,369 people attended and listened to the health messages. A town crier was mobilised to inform villagers of the program just before the singing commenced at each group of houses. An information sheet of key message areas was distributed to respective group members. Key message areas: 1. Antenatal examination a. Minimum of four antenatal visits during pregnancy. 2. Food a. Pregnant women should eat food in every four hours. b. Pregnant woman should take a balance of four foods - rice, vegetables, meat and maize. The recommended Iron tablets should be taken with milk if necessary. 3. Rest a. Eight hours (a pair of four hours) of unbroken sleep is essential for the pregnant woman. b. To ensure a healthy baby, the pregnant woman should not be engaged in heavy work and long hours of work after four months of pregnancy. They should make sure to rest with the weight off their feet every four hours. 4. Preparation for childbirth a. Four key people (father-in-law, mother-in-law, husband and female community health volunteer) should engage in planning for childbirth. b. They should inform health facility or skilled health worker before four weeks of the expected date of delivery. c. The plan of transportation should be finalised four days before the expected date of delivery. The winning songs were taught to local teachers, traditional singers and students who sang the songs in the villages. Songs were sung every day for the period of the intervention. A pictorial wall chart with the key health messages was distributed to each household. In Chitre Village Development Committee the intervention was completed in ten days (from 14th to 23rd July 2016) and in Ramja Deurali Village Development Committee in eight days (from 5th to 12th August 2016).